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BUILD. ' ARTMENT
V E OF RY OK
938 KING ET RYE BR ANY 10573 `Lii
CCT - � tw,3
w oV AGE U7 k:YLDING DEPARTMENT
FOR OFFICE USE ONL4': Jnn
Approval Date: OCT 2� r # ��/f LJ ; Application #
Approval Signature: ARCHITECTURAL. REVIEW BOARD:
Disapproved: Date:
BOT Approval Date: Case# Chairman:
PB Approval Date: Case# Secretary:
ZBA Approval Date: Case#
Other:
Application Fee: lWi2dPermit Fees:
ROOF PERMIT APPLICATION
Q Application dated: -/ /c�-L( is hereby made to the Building Inspector of the Village of Rye Brook,NY,for the issuance of a Permit to
Re-Roof an Existing Building,as per detailed statement described below. /2*Ar `L 5/b4 S/3Sg7 o and y3—�p 8a�
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1. Job Address: C� lzri/ I/Ws- SBL:
Property Owner: 2540V k-4 r7 E / Address: g' 'eiAe# 16n/£
Phone#: ill' --��") J� Cell#: �r('ar"l�y� 1�L�� email: I<A'LIL+4&g <d
2. Applicant: Address:
Phone#: Cell#: emmail"
3. Roofing Contractor: Vy �«•-SMurnc+.� G Le Address: 79� � S�+iT- �6 k3)
NPhone#: Ff E—UP-6 Cell#: 2Y6— q7/ email: 4v4r Sri fap►j
,
4. Job Description,list all Methods&Materials: AfAftw 1i E?r/5 4 7?/51/1f d t frw f
a f7 rj(4 AND 14PLACT 7D MrH'rH Cjris nwk w 17;V lv bAlPf^(15"
e,f f I-vA-� rH/&1-o 01 I'W v T of '-iui-rTA
5. Estimated Cost of Job:S i$/000 .ram (NOTE:The estimated cost shall include all site
impro%cements,labor, material,scaffolding,fixed equipment,professional fees,and material and labor which may be donated gratis.)
5. If corner property,indicate street frontage:
7. Construction Type:S//✓& !1;y/2f NYS Construction Class:
S. Number of stories: ]--W D Height:
9. Is garage being re-roofed:No: OQ•Yes:( )Attached No: ( )•Yes: (X)Number of Cars: 17,4/0
10. Is roof peaked,hip,mansard, flat,etc: Y E S
11. Estimated date of completion:
61112024
Please note that this application must include the notarized signature(s) of the
legal owner(s) of the above-mentioned property, in the space provided below.
Any application not bearing the legal property owner's notarized signature(s)
shall be deemed null and void, and will be returned to the applicant.
TATE OF NEW YO , COUNTY OF WESTCHESTER ) as:
C killer, M 1� I-S f�Mid A(10S ,being duly sworn,deposes and states that he/she is the applicant above named,
rint name of individual signing as the applicant)
and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attorney,etc.)
That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use
conducted at the above captioned property will be in conformance with the details as set forth and contained in this application
and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire
Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Swom to before me this �� Sworn to before me this
day f Q vh` / , 20 IL4 day of 20
Signa re of Property JOvW'er'- Signature of Applicant
Pi
e of Property Owner Print Name of Applicant
a
Notary Public Notary Public
put S.L[odo
NUq�g)j,IC,ST9M OF NEW YOU
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